This report summarises the findings of a review commissioned by India HIV/AIDS Alliance and funded by the European Union of experiences and lessons from integrating HIV and sexual and reproductive health and rights (SRHR) in programmes for key populations which include people living with HIV (PLHIV), sex workers, men who have sex with men (MSM), transgender people and people who use drugs.The report outlines definitions and benefits of HIV/SRHR integration for these key populations and presents some general lessons learned about good practice. It also addresses each of the selected key populations – describing issues to consider within integrated HIV/ SRHR support, sharing key strategies and providing examples of integration in action.
The review was carried out within a context of growing interest in HIV/SRHR integration. There is a growing wealth of evidence that the strategy ‘makes good sense’ and brings concrete benefits – including to people, services and national health systems.
The review specifically responded to the ‘push’ for HIV/SRHR integration within the changing and increasingly complex environment for responses to HIV. Within this context – one characterised by constrained resources, increased demands for cost-efficiency and political re-positioning (with HIV increasingly integrated into wider frameworks for health) – integration is clearly an important strategic option. It also, however, risks being seen as a ‘magic bullet’.
In India – as well as other countries in the Asia and the Pacific Region and globally – there is increasing policy support for the concept of HIV/SRHR integration. However, there remain significant questions and uncertainties about what such programming means in practice. This is particularly the case within the context of a concentrated HIV epidemic – where little is still known about what integration should ‘look like’ (for groups such as sex workers and men who have sex with men) and what practical opportunities and challenges it involves.
However, while integration is a desirable goal in the long-run, concerns remain that the joining of programmes and systems that are not ready could, in fact, compromise the quality of and access to services for key populations. This review identifies a number of challenges and recommendations for SRHR/HIV integrated programmes. These challenges need to be taken into account when national responses aim to scale up SRHR/HIV integrated programming. While this approach clearly has the potential to increase reach and improve quality of interventions, integrating services and systems that are not ready may in the short-run actually compromise outcomes for key populations.
A number of critical questions remain outstanding. These include: Do we have strong evidence to support HIV/SRHR integration as an effective approach to improve both SRHR and HIV outcomes specifically for key populations? If so, what needs to be taken into account to ensure that integration does not compromise access to services for key populations? For example, what type, pace and scale of integration works best for specific populations in specific contexts? And what is possible in the short-term and what goals should be set for long-term?
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